he business case for hospital laboratory outreach programs is clear. Outreach programs expand the traditional role of the hospital lab from providing inpatient testing to serving the full spectrum of lab

testing in the community. As outpatient procedures accelerate and new payment models emerge, such as accountable care organizations (ACOs), hospital clinical lab leaders should collaborate with their IT counterparts and hospital execu- tives to target physician practices, employers and insurance companies that are critical to a hospital’s business success. It is estimated that 70 percent of U.S. hospitals operate an outreach laboratory program at some level. However, only a small percentage of those hospitals are receiving orders and sending results electronically with providers in their service area. Bogged down with workflow challenges related to inpatient testing and lacking access to health information exchange (HIE) capabilities, few hospital laboratory outreach programs can compete with LabCorp and Quest Diagnostics. The pressure to compete with commercial laboratories and the need to serve emerging ACOs will force hospital outreach laboratory programs to harness the power of HIE. Laboratory HIEs are primarily utilized to allow providers to place lab orders and receive results without ever leaving their ambulatory electronic medical record (EMR) workflows. However, formidable workflow complexities within the hospital and excessive interface costs have traditionally kept hospital lab outreach programs from offering this service. Consequently, most hospital lab outreach services force pro- viders to leave their EMR workflow and log on to a Web portal to place lab orders and receive results, creating inefficiency for the provider and the hospital laboratory. Unfortunately, the public HIE initiatives funded by the HITECH provisions of the American Recovery and Reinvestment Act (ARRA) are not getting hospital labs any closer to solving these challenges. Public HIEs have not given hospitals the proper capabilities to support the laboratory testing business. Not designed in the interest of a particular system, public HIEs are generally burdened by governance issues, cost overruns, insufficient funds and competing interests. As visionary health systems become aware of these inefficiencies, they are increasingly beginning to adopt private enterprise HIEs to independently govern, deploy and offer HIE capabilities to their physician partners.

Market research firm IDC Health Insights recently re- ported that enterprise HIEs are becoming the fastest-growing market segment in the HIE space. Empowered by a more-

10 September 2012

sustainable business model and a lack of organizational and data governance issues, enterprise HIEs improve hospital and health system relationships with community physicians while protecting or even increasing ancillary service revenues such as those from hospital laboratory outreach programs.

This ability to provide af- filiated physicians with mean- ingful HIE functionality and demonstrate clear ROI is driv- ing enterprise HIE’s success. In order to effectively exchange data with all providers at all points of care, a hospital laboratory outreach program should adopt an enterprise HIE that can: • Operate within native workflows. Allow doctors to stay within their native systems. Enterprise HIEs that do not force doctors to leave their own environment improve workflow while ensuring that accurate patient data is shared.

• Readily match laboratory orders with patient identities. Enterprise HIEs need to include a sophisticated master patient index in order to run a seamless patient identity matching system for solicited and unsolicited results. A distributed patient identity matching system is neces- sary to eliminate the politics and complexities associ- ated with centralized matching systems. The centralized model has struggled for years to get wide community adoption because physicians have historically been un- willing to give up their patients’ proprietary information to a third-party database for matching purposes.

• Seamlessly integrate with all EMRs. An enterprise HIE must interface with any ONC-ATCB-certified EMR product. Each HIE should come with pre-loaded EMR interface specifications that deliver a “productized” interface process, which means all EMR interfaces look exactly the same to the EMR company no matter the provider’s location. This allows speed to market at a substantially lower cost.

To avoid conceding the lab business to independent com- mercial labs, hospitals must adopt HIEs that can facilitate patient-centric care, improve efficiency and reduce errors. The inefficiency of transmitting laboratory orders and receiv- ing results via paper or outdated Web portals is very apparent and costly. Hospitals who fail to adopt the advanced HIE technologies available today will fail to be competitive in the laboratory market in the future.